糖尿病家族史和三高聚集与糖尿病患病的关系

目的 了解糖尿病家族史和三高聚集与糖尿病患病的关系,为制定适宜的糖尿病防治策略提供参考依据。方法 2019年10月至2020年4月采用多阶段随机抽样的方法,在江苏省南通市海门区随机抽取8981名18周岁以上常住居民,进行问卷调查和体格检查,采用t检验、x2检验、多因素非条件logistic回归研究糖尿病家族史和三高聚集对糖尿病患病的影响。结果 江苏省南通市海门区18周岁以上常住居民最终纳入8350名,糖尿病患病率11.2%,标化患病率5.4%。在调整了性别、年龄、文化程度、职业、总静态时间等混杂因素后,多因素非条件logistic回归分析结果显示,有糖尿病家族史者糖尿病患病风险是无家族史者的3.43倍（OR=3.43,95%CI=2.86～4.11）,超重肥胖者糖尿病患病风险是非超重肥胖者的1.60倍（OR=1.60,95%CI=1.39～1.83）,高三酰甘油血症者糖尿病患病风险是非患者的4.99倍（OR=4.99,95%CI=4.17～5.98）,高血压患者糖尿病患病风险是非患者的3.14倍（OR=3.14,95%CI=2.73～3.62）。当家族史合并1高时,以家族史合并高三酰甘油血症人群的糖尿病患病风险最高（OR=4.60,95%CI=4.01～5.29）,当家族史合并2高时,以家族史合并高三酰甘油血症、超重肥胖人群的糖尿病患病风险最高（OR=4.67,95%CI=4.08～5.37）,当家族史合并3高时,糖尿病患病风险达到最高（OR=5.72,95%CI=5.14～6.42）。结论 家族史合并危险因素聚集越多,糖尿病患病风险越高,应及时做好干预工作。     

失地农民生活方式与其慢性非传染性疾病关联的研究

目的 调查安徽省某地区农民、失地农民和城市人群罹患慢性非传染性疾病的流行现状,探讨失地农民生活方式与慢性非传染性疾病的联系。方法 采用横断面研究方法,共收集有效问卷761份,其中农民组119份,失地农民组259份,城市组383份。计数资料采用χ2检验,计量资料采用方差分析,对各组人群慢性非传染性疾病发病风险进行Logistic回归分析。结果 三组人群在饮酒、膳食习惯和体力活动等生活方式方面差异有统计学意义（均有P<0.05）。Logistic回归分析表明农民组和失地农民组人群高血压和超重肥胖的发病风险低于城市组。调整混杂因素后,农民组（OR=0.20,95%CI:0.12~0.33）和失地农民组（OR=0.65,95%CI:0.44~0.95）高血压发病风险低于城市组,农民组（OR=0.44,95%CI:0.27~0.74）和失地农民组（OR=0.67,95%CI:0.47~0.96）超重肥胖发病风险低于城市组。农民组（OR=2.48,95%CI:1.45~4.23）和失地农民组（OR=2.00,95%CI:1.33~3.02）动脉粥样硬化发病风险高于城市组。结论 失地农民生活方式不同于农民组与城市组,高血压和超重肥胖发病风险高于农民组。应对失地农民人群采取干预措施,预防慢性非传染性疾病发生发展。     

中国人群BMI与肺癌发病风险的Meta分析

目的：探讨肥胖与中国人群肺癌发病风险的关系,分析BMI与肺癌发病风险的剂量-反应关系。方法系统性检索国内外公开发表的有关中国人群BMI与肺癌发病关系的文献,并辅以文献追溯等方法,检索数据库包括中国知网、万方数据知识服务平台、PubMed、Embase和Google Scholar,时间范围从各数据库建库至2014年9月,共检索到93篇文献。采用Meta分析方法计算肥胖与肺癌发病风险的合并OR（95%CI）值,运用广义最小二乘估计方法（GLST）估计BMI与肺癌发病风险的剂量-反应关系。结果最终纳入文献7篇,纳入肺癌病例2351例。Meta分析结果表明,肥胖与肺癌发病风险呈负相关（OR=0.68,95%CI：0.59～0.79）,并且这种负相关不受研究类型、性别、吸烟状况、BMI获取方式和病例来源的影响,异质性检验结果I2=0,P=0.594。BMI与肺癌发病风险呈线性剂量-反应关系,BMI每增加5 kg/m2,肺癌发病风险降低21%（OR=0.79,95%CI：0.71～0.89）,异质性检验结果q=22.43,P=0.002。结论 BMI较高是中国人群肺癌发病的一个保护性因素,由于吸烟是肺癌最重要的危险因素,可能有一定的混杂作用。     

蒙古族高血压遗传及环境危险因素分析

目的探讨蒙古族高血压的遗传环境影响因素。方法在现况调查基础上,以其中无血缘关系的579名蒙古族人（高血压者298人,正常血压者281人）为研究对象进行病例对照研究。调查相关的环境因素并采集血样,对肾素基因一处新发现的插入/缺失（insertion/deletion,I/D）多态性、血管紧张素转换酶基因的插入/缺失（ivseaion/deletion.I/D）多态性,采用PCR技术结合凝胶电泳和银染方法进行基因分型。采用非条件Logistic回归模型进行遗传、环境多因素分析。结果年龄、体质指数（BMI）、每日饮酒量、肾素基因I/D多态性对高血压的发生差异有统计学意义（P〈0.05）。年龄每增加10岁发生高血压的危险性是增加前的1.28倍（OR95%CI=05～1.57）;BMI≥24 kg/m^2发生高血压的危险性是BMI〈24 kg/cm^2的2.44倍（OR95%CI=1.66～3.64）;每日饮酒量每增加一个等级发生高血压的危险性是增加前的1.61倍（OR95%CI=1.25～2.08）;肾素基因I/D多态性以II基因型为参照,ID、DD基因型的OR分别为2.39（OR95%CI=1.31～4.48）,2.41（OR95%CI=1.27～4.68）。结论超重或肥胖、长期过量饮酒是蒙古族人群高血压的危险因素,肾素基因I/D多态性D等位基因可增加蒙古族人群高血压的危险性。     

中国成人腰围、体质指数与高血压关系

目的 采用腰围(WC)、体质指数(BMI)综合评价中国18～69岁成年人中心性肥胖者高血压患病风险.方法 利用2004年中国慢性病及其危险因素监测样本人数,采用多级抽样方法抽取18～69岁成年人30 686人,采用问卷调查和人体测量方法收集数据,比较各BMI组别中心性肥胖者高血压患病的OR值.结果 体质指数正常、超重和肥胖组中,男性中心性肥胖者高血压患病率分别为26.1%,32.0%和49.2%;女性中心性肥胖者高血压患病率分别为22.5%,28.2%和41.5%;除男性肥胖组外,中心性肥胖者高血压患病率均明显高于同组内的正常腰围人数(P<0.01);调整混杂因素(年龄、吸烟状况、饮酒状况和锻炼等)后,与正常腰围人群比较,各BMI组别中男性中心性肥胖者患高血压患病的OR值分别为1.9(95%CI=1.6～2.3),1.6(95%CI=1.3～1.9),1.6(95%CI=0.7～3.7);女性患高血压患病OR值分别为1.5(95%CI=1.3～1.8),1.4(95%CI=0.2～1.6),2.5(95%CI=1.2～5.2).结论 中心性肥胖者与正常腰围者比较具有更高的高血压患病风险.     

成都市就业流动人口高血压患病现状及相关因素分析

目的 了解成都市就业流动人口高血压患病现状并探索其相关因素,为制定流动人口高血压预防策略及措施提供依据。方法 采用应答推动抽样（RDS）法在成都市抽取≥18岁非成都市户籍就业人员进行问卷调查和体格检查。高血压患病率的比较采用x2检验,患病相关因素分析采用多因素logistic回归模型。结果 共调查就业流动人口2351人,高血压患病率为29.82%。Logistic回归结果显示,年龄≥31岁［31～45岁（OR=1.979,95%CI=1.466～2.670）、46～60岁（OR=3.673,95%CI=2.758～4.892）、≥61岁（OR=6.240,95%CI=4.272～9.116）］、吸烟（OR=1.597,95%CI=1.064～2.396）、经常在外就餐/点外卖（OR=1.429,95%CI=1.091～1.871）、超重（OR=2.577,95%CI=1.475～4.503）、肥胖（OR=3.954,95%CI=2.204～7.094）及职业为运输/仓储（OR=1.972,95%CI=1.177～3.304）为高血压患病的危险因素;女性（OR=0.614,95%CI=0.472～0.799）、不饮酒（OR=0.714,95%CI=0.557～0.916）、无高血压家族史（OR=0.687,95%CI=0.556～0.848）是保护因素。结论 成都市就业流动人口高血压患病率较高,需重点关注男性、老年、运输/仓储职业、有高血压家族史的人群高血压患病情况。积极制定和完善流动人口高血压防控策略,针对可改变的危险因素,采取多种干预措施,提高其健康水平。     

中国人群体重指数与食管癌发病风险的Meta分析

摘要:目的　探讨中国人群肥胖与食管癌发病风险的关系,评估BMI与食管癌发病风险的剂量反应关系。方法　系统性检索国内外公开发表的有关中国人群BMI与食管癌发病关系的中英文文献,并辅以文献追溯等方法,检索数据库包括中国知网、万方数据知识服务平台、PubMed、Embase和Google Scholar,时间范围从各数据库建库至2014年9月,共检索到60篇文献。采用Meta分析方法计算肥胖与食管癌发病风险的合并OR值（95%CI）,运用最小二乘估计方法（GLST）估计BMI与食管癌发病风险的剂量反应关系。结果　最终纳入文献5篇,纳入食管癌病例7 215例。Meta分析结果表明,肥胖与中国人群食管癌发病风险呈负相关（OR＝0.56,95%CI:0.35～0.90）,并且这种负相关不受研究类型、地区、BMI获取方式和病例来源的影响。BMI与食管癌发病风险呈线性剂量反应关系,BMI每增加5 kg/m2食管癌发病风险降低（OR＝0.57,95%CI:0.54～0.60）。结论　本次Meta分析结果显示高BMI是中国人群食管癌发病的一个保护性因素。     

江苏省成年居民肥胖与高血压相关关系研究

目的 探讨不同体型人群中超重肥胖、中心性肥胖与高血压患病率、知晓率、治疗率、控制率、治疗控制率相关关系。方法 采用整群随机抽样,对江苏省成年居民进行横断面调查,采用t检验、F检验分析组间差异;采用χ2检验,logistic回归模型计算OR值及95％CI。结果 江苏省成年居民BMI≥24/中心性肥胖率高达47.6%。BMI≥24/中心性肥胖人群的高血压患病率、知晓率、治疗率分别为51.2%、60.6%、54.3%,均高于其他体型人群。BMI＜18.5/非中心性肥胖人群的高血压治疗控制率最高,为60.0%。Logistic 回归分析结果表明,在调整年龄、收入、文化程度及吸烟饮酒状况后,与BMI = 18.5～23.9/非中心性肥胖相比,BMI≥24/中心性肥胖的人群高血压患病风险增加3.111倍（aOR = 3.111,95%CI = 2.665～3.632）。BMI = 18.5～23.9/中心性肥胖人群以及BMI≥24/中心性肥胖人群高血压治疗控制不良风险显著增加,调整OR值分别为0.362（95%CI = 0.155～0.845）和0.579（95%CI = 0.394～0.851）。结论 江苏省成年居民BMI≥24/中心性肥胖率较高,且高血压患病风险最高,中心性肥胖增加高血压治疗控制不良的风险。     

甘肃汉族人群高血压家族史与高血压关联的研究

目的 了解甘肃省20~80岁汉族人群高血压患病现状,探讨高血压家族史（family history,FH）与高血压之间的关系。方法 本研究为横断面研究,采用多阶段分层整群抽样方法,选择甘肃省4个调查地区的汉族人群,进行面对面问卷调查、体格检查和血生化检测。结果 共调查4 247名20~80岁汉族常住居民,问卷应答率为97.4%,合格率为98.7%。其中男性有1 777人（41.8%）,女性有2 470人（58.2%）,高血压粗患病率为28.2%。多因素Logistic回归分析显示,有FH者患高血压的风险比无FH高（OR=3.36,95%CI:2.58~4.41,P<0.001）,当患病亲属从1代增加到2代和3代时,高血压的患病风险从2.33倍（OR=2.33,95%CI:1.77~3.09,P<0.001）增加到5.97倍（OR=5.97,95%CI:4.42~8.13,P<0.001）和14.64倍（OR=14.64,95%CI:8.30~26.27,P<0.001）。结论 有高血压FH的人群高血压患病率明显升高,且随着家族中患病亲属代数的增加,高血压的患病风险逐渐增加。有FH的人能形成一个易于识别的群体,对该群体的针对性干预能够使其受益,从而降低高血压的发病风险。     

痛风患者合并高血压现状及其相关因素分析

目的 了解痛风患者合并高血压的现状,并分析其相关影响因素,为降低痛风合并高血压的患病风险提供科学依据。 方法 采用横断面研究的方法,收集2020年4月—2021年2月来自四川省成都市某风湿专科医院的581例痛风患者,调查其一般人口学特征、生活饮食行为方式,并对其进行体格检查及实验室指标检测。组间差异比较采用检验（或Fisher 精确概率法）,痛风患者合并高血压的相关因素分析采用logistic回归模型,检验水准α= 0.05。 结果 581例痛风患者合并高血压者251例（43.2%）。男性567例（97.6%）,女性14例（2.4%）。单因素分析结果显示,痛风患者合并高血压组与未合并高血压组的年龄、BMI、婚姻状况、痛风病程、痛风类型、痛风石、高强度体力活动、中等强度体力活动、胆固醇（CHOL）、肾小球滤过率（eGFR）、豆类及其制品摄入、红肉摄入、油炸食品摄入、甜品摄入、肉汤摄入的差异有统计学意义（均P＜0.05）。多因素分析结果显示,年龄（与＜40岁相比,40～49岁:OR = 3.41,95%CI:1.64～7.06;50～59岁:OR = 2.93,95%CI:1.28～6.68; ≥60岁:OR = 8.00,95%CI:2.75～23.29）、BMI（与18.5～23.9 kg/m2相比,≥28.0 kg/m2:OR = 3.69, 95%CI:1.96～6.98）、痛风病程（与＜1年相比,≥10年:OR = 2.38,95%CI:1.04～5.40）、CHOL（与＜5.2 mmol/L相比,5.2～6.19mmol/L:OR = 2.51, 95%CI:1.37～4.68）可能为痛风合并高血压的危险因素;饮茶（OR = 0.54,95%CI:0.32～0.93）、禽肉摄入（与≤1次/周相比,≥3次/周:OR = 0.45, 95%CI:0.26～0.79）可能为痛风合并高血压的保护因素。 结论 胆固醇水平较高、肥胖、痛风病程较长且年龄超过40岁可能为痛风合并高血压的独立危险因素。建议痛风患者坚持定期体检,适当增加体力活动,积极控制体重,改善膳食结构,增加优质动物蛋白摄入和适量饮茶。临床医生对痛风患者的日常诊疗中应加强对血脂、血压等指标监测,有利于预防和减缓痛风合并高血压的发生。     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The human drama of genetics: 'hard' and 'soft' media representations of inherited breast cancer

This paper examines media coverage of 'breast cancer genetics', and explores its implications for public understanding. We present a content analysis of coverage in British newspapers and look at a variety of popular forms, including women's magazines, television soap opera and radio drama. Genetic/inherited risk receives a great deal of coverage across a wide range of media formats and outlets. Much of this attention has focused on individuals from 'high risk families' and dilemmas around prophylactic mastectomies. Through examining media coverage, combined with interviews with media personnel and their sources, we show why this story proved so attractive to the media and highlight the different production values which influence coverage. Finally, we introduce preliminary findings from focus group discussions to demonstrate how such 'human interest' framing has engaged audience attention and influenced public understandings. The paper concludes by highlighting the implications for analysing, predicting, and engaging with, media representations of science.     

Worker education in the primary prevention of occupational dermatoses

This paper reports the evaluation of a skin care education programmeconducted on a fine chemicals manufacturing site where over1,000 employees are located. Approximately 60% are involvedin chemical manufacture. Over a 12 month period production staffreceived training in prevention of occupational dermatoses linkedto a site-wide poster initiative. The incidence of new casesof occupational dermatoses fell from 0.055 (70 cases in 1,277employees) to 0.021 (27 cases in 1,277 employees) before andafter the intervention respectively (p<0.0001). After otherfactors such as chemicals handled, observer bias and changesin reporting related to socioeconomic climate were taken intoaccount it is concluded that this study demonstrates the importanceof worker education as a tool for primary prevention of disease.Training materials such as video and poster presentations maybe effectively used in the chemical manufacturing industry asan adjunct to prevention and control of exposure to substanceshazardous to the skin. Such methods may also be used in otherindustries where there are significant risks of dermatoses.     

Regional Variation in Travel-related Illness acquired in Africa,March 1997–May 2011

To understand geographic variation in travel-related illness acquired in distinct African regions, we used the GeoSentinel Surveillance Network database to analyze records for 16,893 ill travelers returning from Africa over a 14-year period. Travelers to northern Africa most commonly reported gastrointestinal illnesses and dog bites. Febrile illnesses were more common in travelers returning from sub-Saharan countries. Eleven travelers died, 9 of malaria; these deaths occurred mainly among male business travelers to sub-Saharan Africa. The profile of illness varied substantially by region: malaria predominated in travelers returning from Central and Western Africa; schistosomiasis, strongyloidiasis, and dengue from Eastern and Western Africa; and loaisis from Central Africa. There were few reports of vaccine-preventable infections, HIV infection, and tuberculosis. Geographic profiling of illness acquired during travel to Africa guides targeted pretravel advice, expedites diagnosis in ill returning travelers, and may influence destination choices in tourism.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

The design of hazard risk assessment matrices for ranking occupational health risks and their application in mining and minerals processing

Two hazard risk assessment matrices for the ranking of occupational health risks are described. The qualitative matrix uses qualitative measures of probability and consequence to determine risk assessment codes for hazard-disease combinations. A walk-through survey of an underground metalliferous mine and concentrator is used to demonstrate how the qualitative matrix can be applied to determine priorities for the control of occupational health hazards. The semi-quantitative matrix uses attributable risk as a quantitative measure of probability and uses qualitative measures of consequence. A practical application of this matrix is the determination of occupational health priorities using existing epidemiological studies. Calculated attributable risks from epidemiological studies of hazard-disease combinations in mining and minerals processing are used as examples. These historic response data do not reflect the risks associated with current exposures. A method using current exposure data, known exposure-response relationships and the semi-quantitative matrix is proposed for more accurate and current risk rankings.